Ebola Now Preoccupies Once-Skeptical Leader in Guinea

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“While shaving I think of Ebola, while eating I think of Ebola,” said President Alpha Condé of Guinea. The response of nearby nations helped galvanize Mr. Condé.CreditSamuel Aranda for The New York Times

But the president of Guinea was just getting started, calling back a few minutes later. “Yes, excellency, to transport the samples, we need good vehicles,” the Ebola czar answered patiently.

Then the president, Alpha Condé, wanted to know about new Ebola treatment centers and the new Ebola database on cellphones. And how about those experimental tests, or the car for the chief of staff?

“I’ll send you the information right away,” answered the Ebola czar, Dr. Sakoba Keita, cradling his head in his hands. After 15 minutes, the president hung up. A rueful smile played on the doctor’s lips. It was 5:30 in the afternoon, but the day was far from over. The president called his Ebola point man back 10 minutes later with more questions.

Guinea went through 50 years of autocracy, military coups, massacres of civilians and plundering by its rulers. Now the aging political outsider elected to govern this nation — who spent much of his adult life in exile in Paris — is mustering a late-career tenacity to confront the deadly epidemic that still infects hundreds in this battered West African nation.

The change of heart has been sharp. At the start of the outbreak, Mr. Condé was incredulous, denying its seriousness and wasting crucial weeks that could have helped contain it.

Predicting “rapid and final success” in late March, he said the situation was “well under control” only a month later, even as health officials under him massaged the numbers to avoid scaring off much-needed investors in his impoverished nation, senior international health officials said.

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President Condé, left, with President François Hollande of France and French soldiers at Conakry Airport on Friday.CreditPool photo by

“They are very much annoyed by Ebola, because of the investors,” a senior Doctors Without Borders official said here in early July. “The government’s first concern was not to scare outsiders. They wanted to minimize the cases.”

Upset by the group’s dire warnings, Mr. Condé publicly criticized Doctors Without Borders, despite its lonely efforts to blunt the disease on the front line. But as Mr. Condé played down the outbreak, Ebola was steadily entrenching itself in the Guinean forest villages where it surfaced nearly a year ago.

Now, after more than a thousand deaths in Guinea, Mr. Condé has reversed course. Disturbed by the threat to his country’s people and economy, he is grappling with Ebola nearly every waking moment. Having initially overlooked the crisis, he is now micromanaging it, some international officials say.

“While shaving I think of Ebola, while eating I think of Ebola, while sleeping I think of Ebola,” Mr. Condé, 76, said at the drab, concrete, Chinese-built presidential palace named for Ahmed Sékou Touré, the nation’s first president and strongman, who forced Mr. Condé into exile in 1970 and condemned him to death in absentia.

“When you are at war, how can you think of anything else?” Mr. Condé said, leaning forward, describing his battle with Ebola in the rapid staccato delivery for which he is known.

Much of Guinea’s political establishment has been compromised by association with the country’s past autocrats, reinforcing the go-it-alone tendencies honed by Mr. Condé’s decades in exile. The soldiers now guarding the presidential palace are aggressively loyal: Mr. Condé was the target of an assassination attempt at his home by restive army officers three years ago.

A new coup is never far from his thoughts. During a news conference on Ebola last month, he veered off to warn that “those who are dreaming of a coup d’état, they are kidding themselves.”

With an academic attention to minutiae, Mr. Condé, a former Sorbonne law professor with connections to the financier George Soros and others in the global elite, is now involved in the Ebola struggle down to the smallest details. (Even official communiqués refer to him as “the professor.”)

The amount of gas needed for motorcycles carrying disease monitors, the benefits of camera thermometers versus hand-held ones, the construction details for treatment centers, the vehicles to transport patient samples — nothing is too small to escape his attention.

Despite his own belated activism, he is furious with what he sees as incompetence. When it took months to deliver vital medicine, he assailed the World Health Organization for the holdup.

“The W.H.O. said, ‘Mea culpa,’ ” he said. “I said, ‘It is not a question of mea culpa. This is a crime.’ ” (A W.H.O. official disputed the president’s characterization of the episode, saying the medical supplies were not linked to Ebola, and were not urgently needed).

Not trusting his own bureaucracy — the president is curtly dismissive of his own aides, even in front of strangers — Mr. Condé has created what amounts to an alternative one, according to diplomats and international health officials.

“He’s in a trap,” said a senior diplomat here. “There is no bureaucracy to carry out his writ. So he builds parallel structures with some individual.”

The principal one is Dr. Keita, appointed as Ebola coordinator in September at the urging of the United States Centers for Disease Control and Prevention, bypassing the hitherto ineffective Health Ministry. Diplomats and health officials here praise the efficiency of Dr. Keita, Guinea’s longtime top epidemic prevention official, describing him as the government’s de facto No. 2, just under Mr. Condé himself.

But the president — who spent more than a year in the humid jails of the former dictator Lansana Conté with only “rats, cockroaches and mosquitoes” for company, according to his memoirs — is the one who gives the orders.

“As far as Guinea is concerned, it is me who decides,” Mr. Condé said. “What is it that we need? I will fight to get it.”

Some wonder if he is too closely involved.

“What is hallucinatory here is that it is the president who is managing the epidemic,” said the Doctors Without Borders chief of mission here, Marc Poncin. “He’s implicating himself too directly in everything.”

Recently angered that work was proceeding too slowly on a treatment center, Mr. Condé “threatened jokingly to put the guy in jail if he didn’t start construction immediately,” Mr. Poncin recalled.

“He is in a hurry,” Dr. Keita said.

It was not always so. At first, “there was pressure to downplay,” said a C.D.C. official who was not authorized to speak publicly. So “there was a decision by the government; they removed probable and suspect cases” from the official disease tally, the official said, eliminating two categories essential for assessing the extent of the outbreak.

“We need to not scare people and companies and airlines,” the C.D.C. official recalled the Guinean Health Ministry official leading the response saying. “He spoke of patriotic duty.”

For many Ebola victims, it is difficult, if not impossible, to get an official test to confirm the virus. But Dr. Aboubacar Sidiki Diakité, the Health Ministry official leading the response at the time, argued that only confirmed cases would be understood by the public.

“When you speak of ‘probable, suspect and confirmed,’ the population doesn’t understand what is ‘probable’ and ‘suspect,’ ” Dr. Diakité said in an interview last week. “You have to understand the structure of Guinean society. You’re not talking about intellectuals.”

Dr. Diakité added that “you have to communicate for everybody” and that “we were in that logic: positive communication.”

As for Mr. Condé’s handling of the crisis early on, “he didn’t want to see things directly,” said Mr. Poncin of Doctors Without Borders. “He thought it could be managed.”

That response didn’t work. The disease was festering in Guinea’s remote villages and spreading into Sierra Leone and Liberia, fueling the epidemic.

By August, with Guinea’s neighbors in Ivory Coast and Senegal closing their borders, its economy going into reverse and Ebola deaths piling up, the president underwent a conversion in desperation, according to diplomats and health officials.

“In August, I think he realized the gravity of the situation,” Mr. Poncin said. “That’s why he is interesting, because he admitted in front of everybody that he had been wrong.”

Now, Dr. Keita, the Ebola czar, speaks to the president “four or five times a day,” he said. “So yes, there are close relations between me and him,” he said.

There is still much to be done: The authorities, with international help, are installing provisional treatment centers in hot spots where the disease is smoldering.

Mr. Poncin said there had been a new “deterioration” in Guinea, with a sharp increase in cases likely and the spread of the disease into relatively unaffected regions.

“I have got to keep him very closely informed,” Dr. Keita said of the president.

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